CMIS. Insurance Specialist (CMIS) Certified Medical CMIS. Class size is limited to 25 to maximize learning experience.

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "CMIS. Insurance Specialist (CMIS) Certified Medical CMIS. Class size is limited to 25 to maximize learning experience."

Transcription

1 CMIS Certified Medical Insurance Specialist (CMIS) Class size is limited to 25 to maximize learning experience. CMIS Understand payer models and rules for accurate claim filing and reimbursement. Improving the business of medicine through education

2 This certification program explores the current landscape of third party reimbursement. Detailed lecture, course materials and examples will teach participants how to effectively expedite claims, secure timely, correct reimbursement, and protect the financial interest of the practice. CMIS Coding expertise is the foundation. But if you want to get paid, then you ll need to know the rules. How good is your billing team? Are your claim follow-up procedures effective? Are ABNs and authorizations being processed correctly?. Has your ratio of outstanding claims decreased in the last 2 years? Are your aging reports under control? There s room for improvement in every practice. Seasoned coding and billing professionals will work through level-of-service examples that include modifier selection and how it corresponds to medical necessity. Today more than ever, your team must be trained to focus on getting every dollar rightfully owed to the practice. This program will teach you how to master the entire process, better train those around you, and enhance your professional skills and value. The Certified Medical Insurance Specialist (CMIS) program has passed a thorough review process, ensuring that materials are current and accurate, and testing standards are strictly enforced. Board and faculty members have real-world experience in all aspects of running a successful medical practice. Representatives include seasoned physicians, educators, accountants, compliance officers and senior executives in medical practice management. CPT is a registered trademark of the American Medical Association. All rights reserved.

3 Class Outline Role and Responsibilities Differentiate between medical ethics and medical etiquette Learn essential ways to keep insurance and medical knowledge current Demonstrate the importance of accurate coding, billing and claims submission Compliance Major categories of security safeguards under HIPAA and civil/criminal non-compliance penalties The Privacy Rule and the definition and explanation of protected health information (PHI) Definition of fraud and abuse and potential fines/penalties related to fraudulent claims Health information technology expansion: ARRA, HITECH and the creation of incentive payments to eligible providers Basics of Health Insurance The difference between an implied and an expressed physician-patient contract Actions to prevent problems when given signature authorization for insurance claims Physician Fee Schedule - RVUs and RBRVS MACRA and repeal of SGR formula Medical Documentation Identify principles and steps of the documentation Definitions for common medical, diagnostic and legal terms Reasons why an insurance company may decide to perform an external audit ICD-10-CM Diagnostic Coding The purpose and importance of coding diagnoses to the highest level of specificity Features and use of ICD-10-CM code book for accurate code selection In-class diagnostic coding exercises Determine medical necessity by using LCDs and NCDs Procedural Coding The importance and usage of modifiers in procedure coding Code problems from worksheet using the CPT manual The difference between CPT, HCPCS, and Category II codes Use of the NCCI edits to prevent denials The Paper Claim: CMS-1500 Minimize the number of insurance forms returned because of improper completion Detailed look at the new CMS-1500 and what each section contains Expedite the handling and processing of the CMS-1500 insurance claim form Explain the difference between clean, rejected, incomplete, and invalid claims Electronic Data Interchange:Transactions and Security Learn the transaction and code set standards used to share data between clinicians and third-party payers The difference between carrier-direct and clearinghouse electronically transmitted claims How to conquer potential computer transmission problems The use of EDI standards improve the accuracy of information exchanged between healthcare organizations Streamline business processes by using EDI standards as an eligibility and claims processing gateway Full course description pmimd.com/cmis

4 Receiving Payments and Insurance Problem Solving Objectives of state insurance commissioners/state medical societies Communicate problems with insurance commissioners/state medical societies Denials and what they mean; how to appeal for maximum reimbursement Levels of review and redetermination in the Medicare program Sample letters of appeals for claims Office and Insurance Collection Strategies Guidance on state prompt pay laws and the use of financial reports for more effective collections Patient credit options and the best practices for self-pay accounts Effective uses of a billing service, collection agency, and credit bureau in the collection process The effects of the Affordable Care Act provisions on collections Managed Care Plans Explanation of the types of managed care plans Types of authorizations for medical services, tests, and procedures Patient access to care via Accountable Care Organizations and Patient-centered Medical Homes Special issues when patients are insured through the Health Insurance Exchanges Medicare Utilize the lifetime beneficiary claim authorization and information release document How to submit claims for Medicare beneficiaries with supplemental insurance Proper execution of an Advanced Beneficiary Notice (ABN) Medicare as a secondary payer rules Medicaid and Other State Programs Medicaid managed care system guidelines, terminology, abbreviations, eligibility classifications, benefits and non-benefits Medicaid claims filing for patients who have other coverage Minimize Medicaid rejections due to improper form completion Workers Compensation Workers compensation insurance vs. employer s liability insurance Types of compensation benefits for non-disability, temporary, and permanent disability claims Follow-up actions for delinquent worker s comp claims Disability Income Insurance and Disability Benefit Programs Explanation and eligibility requirements for disability benefit programs and insurance plans Terminology and abbreviations for disability insurance and benefit programs How to determine whether disability is considered temporary or permanent State eligibility requirements, benefits, and limitations of SSDI and SSI About PMI Practice Management Institute (PMI) teaches physicians and their staffs how to run a more productive, profitable and compliant medical office. Each year, thousands of medical office professionals look to PMI as a leading provider of continuing education and credentialing. These training programs have been hosted in leading hospitals, medical societies and colleges across the U.S. for more than 30 years. PMI awards certification by exam to accomplished medical office professionals in the competency areas of coding, reimbursement, compliance and management. More than 19,000 have earned credentials through PMI. Learn more now. Visit: pmimd.com.

5 Program Information Fee: $999 Class size is limited to 25 to maximize learning experience. This program includes classroom instruction, course manual, homework exercises, exam preparation handbook, and certification exam. Participants may take up to four hours to complete the CMIS exam. A passing score of 70% or better is required to earn the CMIS certification designation. Course Prerequisite Working knowledge of medical insurance processing in an outpatient setting is recommended. Participants with less than one year of experience should complete supplemental coding and medical records training prior to enrolling in this program. A Medical Coding Basics training package is available on PMI s website: Required Class Materials Participants must bring current editions of CPT, HCPCS, ICD-10-CM coding manuals, and a medical dictionary to class. The Certified Medical Insurance Specialist (CMIS) program is approved for up to 20 CEUs for PMI Certified Professionals (CMC/CMOM/CMCO). All others seeking CEUs should verify credit guidelines with their organization prior to enrollment. 4 ways to earn your CMIS LIVE CLASSROOM Live classes are hosted by leading hospitals, healthcare organizations, medical societies and colleges across the U.S. Live Webinar Up to twelve 90-minute live webinar sessions.* Visit pmimd.com for live webinar dates. *Webinar attendance is encouraged but not required. All recordings can be accessed online anytime (approximately hours after the original recording date). Self Paced Webinar Series Start anytime with access to pre-recorded webinars. Get support while you learn via PMI s online Q & A Forum. Certification by Exam For experienced professionals, an Exam Only option is available for $299 testing fee which includes a basic exam guide and one live proctored exam. To Register: Visit pmimd.com or Call (800) Registration Discounts: PMI Certified Professionals with an active PMI certification (CMC, CMIS, CMOM, CMCO) receive 10% off their registration fee. Certification ID required at registration. Multiple Registrant Discount: If registering two or more participants from the same practice, the second through the fourth registrant all receive 10% off. Five or more registering together all receive 15% off the published registration fee. These standard discounts may not be combined with any other discount offer. Payment Plan Available: Visit pmimd.com/paymentplan.asp or call for more details Practice Management Institute CMIS-1215

CMOM CMOM. Certified Medical. Office Manager (CMOM) Class size is limited to 25 to maximize learning experience. Leadership training and certification

CMOM CMOM. Certified Medical. Office Manager (CMOM) Class size is limited to 25 to maximize learning experience. Leadership training and certification CMOM Certified Medical Office Manager (CMOM) Class size is limited to 25 to maximize learning experience. CMOM Leadership training and certification Improving the business of medicine through education

More information

CERTIFIED MEDICAL INSURANCE SPECIALIST

CERTIFIED MEDICAL INSURANCE SPECIALIST CERTIFIED MEDICAL INSURANCE SPECIALIST CANDIDATE PREPARATION HANDBOOK About the Exam Exam Tips Exam Study Guide Sample Exam Questions Copyright 2015, by Assistex, Inc., San Antonio, TX, all rights reserved.

More information

WEEK CHAPTER OBJECTIVES ASSIGNMENTS & TESTS 19-20 6A medical necessity as it ICD-9-CM Coding. relates to reporting diagnosis codes on claims.

WEEK CHAPTER OBJECTIVES ASSIGNMENTS & TESTS 19-20 6A medical necessity as it ICD-9-CM Coding. relates to reporting diagnosis codes on claims. HEALTH INSURANCE & CODING Textbook: Understanding Health Insurance: A Guide to Billing and Reimbursement 11 th edition Website Activities: StudyWARE Online Practice Software linked to the book. SimClam:

More information

MEDICAL BILLING & CODING PROGRAM

MEDICAL BILLING & CODING PROGRAM ELIM OUTREACH TRAINING CENTER 1820 Ridge Rd Suite 300-301 Homewood, IL 60430 Tel:708-922-9547-Fax: 708-922-9568 E-mail: elim1820@comcast.net Website: elimotc.com MEDICAL BILLING & CODING PROGRAM ELIM OUTREACH

More information

MEDICAL BILLING & CODING PROGRAM

MEDICAL BILLING & CODING PROGRAM ELIM OUTREACH TRAINING CENTER 1820 Ridge Rd Suite 300-301 Homewood, IL 60430 Tel:708-922-9547-Fax: 708-922-9568 E-mail: elim1820@comcast.net Website: elimotc.com MEDICAL BILLING & CODING PROGRAM ELIM OUTREACH

More information

HIPAA: AN OVERVIEW September 2013

HIPAA: AN OVERVIEW September 2013 HIPAA: AN OVERVIEW September 2013 Introduction The Health Insurance Portability and Accountability Act of 1996, known as HIPAA, was enacted on August 21, 1996. The overall goal was to simplify and streamline

More information

The benefits of electronic claims submission improve practice efficiencies

The benefits of electronic claims submission improve practice efficiencies The benefits of electronic claims submission improve practice efficiencies Electronic claims submission vs. manual claims submission An electronic claim is a paperless patient claim form generated by computer

More information

Section 9. Claims Claim Submission Molina Healthcare PO Box 22815 Long Beach, CA 90801

Section 9. Claims Claim Submission Molina Healthcare PO Box 22815 Long Beach, CA 90801 Section 9. Claims As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your

More information

HIPAA Administrative Simplification and Privacy (AS&P) Frequently Asked Questions

HIPAA Administrative Simplification and Privacy (AS&P) Frequently Asked Questions HIPAA Administrative Simplification and Privacy (AS&P) Frequently Asked Questions ELECTRONIC TRANSACTIONS AND CODE SETS The following frequently asked questions and answers were developed to communicate

More information

A. CPT Coding System B. CPT Categories, Subcategories, and Headings

A. CPT Coding System B. CPT Categories, Subcategories, and Headings OST 148 MEDICAL CODING, BILLING AND INSURANCE COURSE DESCRIPTION: Prerequisites: None Corequisites: None This course introduces CPT and ICD coding as they apply to medical insurance and billing. Emphasis

More information

Anthem Workers Compensation

Anthem Workers Compensation Anthem Workers Compensation ICD-10 Frequently Asked Questions What is ICD-10? International Classification of Diseases, 10th Revision (ICD-10) is a diagnostic and procedure coding system endorsed by the

More information

2016 Certification Course / CMBP Designation

2016 Certification Course / CMBP Designation 2016 Certification Course / CMBP Designation 1. INTRODUCTION TO MEDICAL BILLING Introduction to Medical Billing About Medical Billing Certification Requirements for a Medical Biller Medical Billing vs

More information

Ross D. Seymour, MTPM

Ross D. Seymour, MTPM Health Care Reform and Funding Incentives Ross D. Seymour, MTPM HIPAA Certified Project Manager Orange, California Disclosure This presentation was current at the time it was published. Medicare policy

More information

Payment Policy. Evaluation and Management

Payment Policy. Evaluation and Management Purpose Payment Policy Evaluation and Management The purpose of this payment policy is to define how Health New England (HNE) reimburses for Evaluation and Management Services. Applicable Plans Definitions

More information

Coding and Payment Guide for Anesthesia Services

Coding and Payment Guide for Anesthesia Services Coding and Payment Guide for Anesthesia Services An essential coding, billing, and payment resource for anesthesiology and pain management 2006 4th edition Contents Introduction...............................

More information

3 Learning Objectives (cont d.)

3 Learning Objectives (cont d.) 1 2 Learning Objectives Summarize advantages of electronic claim submission. Identify the transactions and code sets to use for insurance claims transmission. State which insurance claim data elements

More information

Molina Healthcare of Ohio, Inc. PO Box 22712 Long Beach, CA 90801

Molina Healthcare of Ohio, Inc. PO Box 22712 Long Beach, CA 90801 Section 9. Claims As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your

More information

Compensation and Claims Processing

Compensation and Claims Processing Compensation and Claims Processing Compensation The network rate for eligible outpatient visits is reimbursed to you at the lesser of (1) your customary charge, less any applicable co-payments, coinsurance

More information

Program and list of learning outcomes from syllabi, with highlighted essential learning outcomes that will be assessed in future for program outcomes

Program and list of learning outcomes from syllabi, with highlighted essential learning outcomes that will be assessed in future for program outcomes Key Core Courses for Health Care Office Management Program and list of learning outcomes from syllabi, with highlighted essential learning outcomes that will be assessed in future for program outcomes

More information

Transitioning from ICD-9-CM to ICD-10-CM. Tidewater Physicians Multispecialty Group Williamsburg, VA

Transitioning from ICD-9-CM to ICD-10-CM. Tidewater Physicians Multispecialty Group Williamsburg, VA Transitioning from ICD-9-CM to ICD-10-CM Tidewater Physicians Multispecialty Group Williamsburg, VA February 22, 2014 Our Agenda Some guidelines for this morning s presentation Our Transformational Point

More information

Medical Assisting Review

Medical Assisting Review Fifth Edition Medical Assisting Review Passing the CMA, RMA, and CCMA Exams Chapter 14 Medical Insurance 14-2 Learning Outcomes 14.1 Define terminology used in association with medical insurance. 14.2

More information

How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice

How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice Janice Crocker, MSA, RHIA, CCS, CHP Introduction Reimbursement for medical practices has been impacted by various trends and

More information

Proprietary information of MedCost, LLC. Do not distribute or reproduce without express permission of MedCost.

Proprietary information of MedCost, LLC. Do not distribute or reproduce without express permission of MedCost. North Carolina Health Insurance Institute October 10-11, 2013 Greensboro, NC 1 What s New With MedCost? We are celebrating 30 years of being in business. 2 A New Web Site and Logo 3 Enhanced Information

More information

MEDICAL INSURANCE SERIES

MEDICAL INSURANCE SERIES MEDICAL INSURANCE SERIES Occ. Work Prob. Effective Last Code No. Class Title Area Area Period Date Action 4581 Medical Insurance Representative 04 445 6 mo. 07/01/12 Rev. 4582 Medical Insurance Associate

More information

Certification Pathways. Additional Business Office Certifications

Certification Pathways. Additional Business Office Certifications Certification Pathways PAC: Patient Access Certification PAS: Patient Access Specialist Cert Annual Patient Access Recertification Billing Prerequisite BC: Billing Certification BSC: PFS/Billing Specialist

More information

Certified Healthcare Auditor [CHA]

Certified Healthcare Auditor [CHA] Presents Certified Healthcare Auditor [CHA] Advanced Training & Certification Become a Certified Healthcare Auditor (CHA) A comprehensive distance learning course for providers, compliance officer and

More information

Meaningful Use, ICD-10 and HIPAA 5010 Overview, talking points and FAQs

Meaningful Use, ICD-10 and HIPAA 5010 Overview, talking points and FAQs Meaningful Use, ICD-10 and HIPAA 5010 Overview, talking points and FAQs Providence Health & Services is committed to using technology and evidence-based practices to deliver the highest quality care in

More information

Certified Coder Training

Certified Coder Training Certified Coder Training Important Information It is important to note that this is not a community college level course! Our instruction is done at a higher level and faster pace. Many people who have

More information

Final. National Health Care Billing Audit Guidelines. as amended by. The American Association of Medical Audit Specialists (AAMAS)

Final. National Health Care Billing Audit Guidelines. as amended by. The American Association of Medical Audit Specialists (AAMAS) Final National Health Care Billing Audit Guidelines as amended by The American Association of Medical Audit Specialists (AAMAS) May 1, 2009 Preface Billing audits serve as a check and balance to help ensure

More information

SPRING/SUMMER 2016 ONLINE CLASSES

SPRING/SUMMER 2016 ONLINE CLASSES 1 SPRING/SUMMER 2016 ONLINE CLASSES What to Expect with these Online Courses All classes meet online. Just turn on your computer, Go to Internet, Enter Online classroom. Instructor available to give you

More information

Revenue Cycle Management: The steps Title X agencies must take to get paid

Revenue Cycle Management: The steps Title X agencies must take to get paid Revenue Cycle Management: The steps Title X agencies must take to get paid Webinar 2: Revenue Cycle Management: After the Client Visit August 7 th, 2013 Intended Audience Title X Grantee and sub-recipient

More information

Management Report Services. Staff Training and Education Services

Management Report Services. Staff Training and Education Services Management Report Services Your management team will receive reports that are clear, well defined and serve as a tool for increased performance. These include a brief description emphasizing how the information

More information

Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule

Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule Many physician practices recognize the Health Information Portability and Accountability Act (HIPAA) as both a patient

More information

FAQs on Billing for Health and Behavior Services

FAQs on Billing for Health and Behavior Services FAQs on Billing for Health and Behavior Services by Government Relations Staff January 29, 2009 Practicing psychologists are eligible to bill for applicable services and receive reimbursement from Medicare

More information

MEDICARE ADVANTAGE PRIVATE FEE FOR SERVICE (PFFS) PLAN 2009 TERMS AND CONDITIONS OF PAYMENT. Table of Contents

MEDICARE ADVANTAGE PRIVATE FEE FOR SERVICE (PFFS) PLAN 2009 TERMS AND CONDITIONS OF PAYMENT. Table of Contents MEDICARE ADVANTAGE PRIVATE FEE FOR SERVICE (PFFS) PLAN 2009 TERMS AND CONDITIONS OF PAYMENT 1. Introduction Table of Contents 2. When a provider is deemed to accept Blue Cross of Idaho Flexi Blue PFFS

More information

HI-1015 - Insurance Billing Specialist

HI-1015 - Insurance Billing Specialist Course Introduction Course Introduction HI-1015 - Insurance Billing Specialist Chapter 01 - The Insurance Billing Specialist The Insurance Billing Specialist Role and Responsibilities Role of the Insurance

More information

Profit Plus Infotech Solutions FZC Synergy Through Partnerships

Profit Plus Infotech Solutions FZC Synergy Through Partnerships Profit Plus Infotech Solutions FZC Synergy Through Partnerships Let us optimize your profit.. while you focus on your practice Medical Billing & E-Claim Processing Medical Coding Electronic Health Records

More information

Kareo Managed Billing Service Q4 2016

Kareo Managed Billing Service Q4 2016 Kareo Managed Billing Service Q4 2016 This document is intended to outline what you can expect from Kareo, and what Kareo expects from you (at a detailed level) as part of the Kareo Managed Billing Service.

More information

The Transition to Version 5010 and ICD-10

The Transition to Version 5010 and ICD-10 The Transition to Version 5010 and ICD-10 An Overview Denise M. Buenning, MsM Director, Administrative Simplification Group Office of E-Health Standards and Services Centers for Medicare & Medicaid Services

More information

Glossary of Terms. Account Number/Client Code. Adjudication ANSI. Assignment of Benefits

Glossary of Terms. Account Number/Client Code. Adjudication ANSI. Assignment of Benefits Account Number/Client Code Adjudication ANSI Assignment of Benefits Billing Provider/Pay-to-Provider Billing Service Business Associate Agreement Clean Claim Clearinghouse CLIA Number (Clinical Laboratory

More information

SYLLABUS. Credits: 4 Lecture Hours: 3 Lab/Studio Hours: 2

SYLLABUS. Credits: 4 Lecture Hours: 3 Lab/Studio Hours: 2 Code: HITC 224 Title: Coding & Classification Systems II Division: Health Sciences Department: Allied Health Course Description: In this course the student will study the principles of coding and classification

More information

Preparing for the Conversion from ICD-9 to ICD-10: What You Need to Be Doing Today

Preparing for the Conversion from ICD-9 to ICD-10: What You Need to Be Doing Today Preparing for the Conversion from ICD-9 to ICD-10: What You Need to Be Doing Today Currently in the United States, ICD-9 is the code set used to report diagnoses and inpatient procedures. ICD-9 stands

More information

ICD-10 Frequently Asked Questions

ICD-10 Frequently Asked Questions ICD-10 Frequently Asked Questions ICD-10 General Overview... 3 What is ICD-10?... 3 Why are we adopting ICD-10?... 3 What are the benefits of the ICD code expansion?... 3 What does ICD-10 compliance mean?...

More information

Health Information Management Compliance

Health Information Management Compliance Health Information Management Compliance A Model Program for Healthcare Organizations 2002 Edition Sue Prophet, RHIA, CCS Contents About the Author....................................................vii

More information

National Council for Behavioral Health

National Council for Behavioral Health National Council for Behavioral Health Preparing your Organization for ICD-10 Implementation Presented by: Michael D. Flora, MBA, M.A.Ed, LCPC, LSW Senior Operations and Management Consultant David R.

More information

Frequently Asked Questions About Your Hospital Bills

Frequently Asked Questions About Your Hospital Bills Frequently Asked Questions About Your Hospital Bills The Registration Process Why do I have to verify my address each time? Though address and telephone numbers remain constant for approximately 70% of

More information

HIT 255 MEDICAL BILLING AND REIMBURSEMENT METHODOLOGIES Spring Semester 2012

HIT 255 MEDICAL BILLING AND REIMBURSEMENT METHODOLOGIES Spring Semester 2012 HIT 255 MEDICAL BILLING AND REIMBURSEMENT METHODOLOGIES Spring Semester 2012 Instructor Mary Jo Jenkins, MPH, RHIA Email address Instructor Office Hours Contact Information mjenkins@pipeline.sbcc.edu but

More information

MEDICAL CODING AND INSURANCE

MEDICAL CODING AND INSURANCE MEDICAL CODING AND INSURANCE DIPLOMA 50 CREDITS About this program The Medical Coding and Insurance diploma program prepares students in many of the procedures associated with billing for medical services.

More information

Frequently Asked Questions about ICD-10-CM/PCS

Frequently Asked Questions about ICD-10-CM/PCS Frequently Asked Questions about ICD-10-CM/PCS Q: What is ICD-10-CM/PCS? A: ICD-10-CM (International Classification of Diseases -10 th Version-Clinical Modification) is designed for classifying and reporting

More information

PELLISSIPPI STATE TECHNICAL COMMUNITY COLLEGE MASTER SYLLABUS MEDICAL INSURANCE CODING OST 2940

PELLISSIPPI STATE TECHNICAL COMMUNITY COLLEGE MASTER SYLLABUS MEDICAL INSURANCE CODING OST 2940 PELLISSIPPI STATE TECHNICAL COMMUNITY COLLEGE MASTER SYLLABUS MEDICAL INSURANCE CODING OST 2940 Class Hours: 3.0 Credit Hours: 3.0 Laboratory Hours: 0.0 Date Revised: Spring 00 Catalog Course Description:

More information

Region V Training Project 3rd Party Billing Practices for Title X Clinics Outline October 13, 2011

Region V Training Project 3rd Party Billing Practices for Title X Clinics Outline October 13, 2011 1 Region V Training Project 3rd Party Billing Practices for Title X Clinics Outline October 13, 2011 The "Affordable Care Act" is coming on-line and has significant implications for the provision of Reproductive

More information

Elmira Business Institute Medical Billing (MED 130) Elmira Business Institute Student Syllabus: Medical Billing (MED 130) Semester: Spring 2014

Elmira Business Institute Medical Billing (MED 130) Elmira Business Institute Student Syllabus: Medical Billing (MED 130) Semester: Spring 2014 Instructor Information: Instructor: Office Location: Telephone: Email: Office and Tutoring Hours: Elmira Business Institute Student Syllabus: Medical Billing (MED 130) Semester: Spring 2014 Course Identification:

More information

Virginia s Free Clinics as Medicaid Providers: Mechanics and Considerations in Establishing a Billing Infrastructure

Virginia s Free Clinics as Medicaid Providers: Mechanics and Considerations in Establishing a Billing Infrastructure Virginia s Free Clinics as Medicaid Providers: Mechanics and Considerations in Establishing a Billing Infrastructure This document is one in a series of tools and white papers produced by the Virginia

More information

CLAIMS Section 5. Overview. Clean Claim. Prompt Payment. Timely Claims Submission. Claim Submission Format

CLAIMS Section 5. Overview. Clean Claim. Prompt Payment. Timely Claims Submission. Claim Submission Format Overview The Claims department partners with the Provider Relations, Health Services and Customer Service departments to assist providers with any claims-related questions. The focus of the Claims department

More information

HIT 255 MEDICAL BILLING AND REIMBURSEMENT METHODOLOGIES Fall 2011

HIT 255 MEDICAL BILLING AND REIMBURSEMENT METHODOLOGIES Fall 2011 HIT 255 MEDICAL BILLING AND REIMBURSEMENT METHODOLOGIES Fall 2011 Instructor Email address Instructor Office Hours Contact Information Office hours location Shawna Sweeney, MSHI, RHIA, CCS Use Moodle Course

More information

MediRegs Coding Suite

MediRegs Coding Suite MediRegs Coding Suite Specialized health care solutions to accelerate coding compliance and ensure accurate and timely reimbursement MediRegs Coding Suite from Wolters Kluwer Law & Business is a web-based

More information

2. For all clinical trials, the coverage analysis will also be audited to ensure compliance with the Medicare National Coverage Determination.

2. For all clinical trials, the coverage analysis will also be audited to ensure compliance with the Medicare National Coverage Determination. COMPLIANCE PROGRAM POLICY: Clinical Research Billing Audit Policy Effective Date: August 1, 2014 Last Updated: Page 1 of 8 I. POLICY All UC Irvine Health departments engaged in clinical research may be

More information

Revenue Cycle Management + Value-Based Medicine

Revenue Cycle Management + Value-Based Medicine Revenue Cycle Management + Value-Based Medicine Presented by: Justin T. Barnes, VP of Industry & Government Affairs Bryan Koch, VP of Revenue Cycle Solutions Safe harbor Safe harbor statement under the

More information

Optum Intelligent EDI. Achieve higher first-pass payment rates and help your organization get paid quickly and accurately.

Optum Intelligent EDI. Achieve higher first-pass payment rates and help your organization get paid quickly and accurately. Optum Intelligent EDI Achieve higher first-pass payment rates and help your organization get paid quickly and accurately. The new benchmark for EDI performance Health care has outgrown commoditized EDI,

More information

Managed Care Contracting

Managed Care Contracting Managed Care Contracting April 08, 2011 WSOPP Presented by: Carrie Romandine Chris Duprey Agenda What is Managed Care Contracting Contracting Process Contract Review Terms and Conditions to Negotiate How

More information

Check the url for more information http://www.careerstep.com/ap/greatbasin

Check the url for more information http://www.careerstep.com/ap/greatbasin Great Basin College is offering online training for Inpatient/Outpatient Medical Coding and Billing Certificate of Achievement (34 credits) Or Recognition of Achievement (28 Credits) will begin in Fall

More information

Compensation and Claims Processing

Compensation and Claims Processing Compensation and Claims Processing Compensation The network rate for eligible outpatient visits is reimbursed to you at the lesser of (1) your customary charge, less any applicable co-payments, coinsurance

More information

HIPAA. HIPAA and Group Health Plans

HIPAA. HIPAA and Group Health Plans HIPAA HIPAA and Group Health Plans CareFirst BlueCross BlueShield is the business name of CareFirst of Maryland, Inc. and is an independent licensee of the Blue Cross and Blue Shield Association. Registered

More information

Molina Healthcare of Puerto Rico (MHPR) Non-Participating Provider Information

Molina Healthcare of Puerto Rico (MHPR) Non-Participating Provider Information Molina Healthcare of Puerto Rico (MHPR) Non-Participating Provider Information Please refer to Carta Normativa 15-0326 Re Transicion for details regarding the ASES-established Transition of Care and Reimbursement

More information

PELLISSIPPI STATE COMMUNITY COLLEGE MASTER SYLLABUS HEALTH CARE INSURANCE SURVEY ADMN 2950

PELLISSIPPI STATE COMMUNITY COLLEGE MASTER SYLLABUS HEALTH CARE INSURANCE SURVEY ADMN 2950 PELLISSIPPI STATE COMMUNITY COLLEGE MASTER SYLLABUS HEALTH CARE INSURANCE SURVEY ADMN 2950 Class Hours: 3.0 Credit Hours: 3.0 Laboratory Hours: 0.0 Revised: Spring 2014 Catalog Course Description: A study

More information

Resources to Help You Prepare for ICD-10 Frequently Asked Questions

Resources to Help You Prepare for ICD-10 Frequently Asked Questions Exchanges Provider FAQ Resources to Help You Prepare for ICD-10 Frequently Asked Questions Overview Oct. 1, 2015 is the compliance date for the transition to ICD-10 coding to replace ICD-9. These codes

More information

COURSE INFORMATION FORM

COURSE INFORMATION FORM DATE SUBMITTED 4/4/14 CATALOG NO. HIM 214 DATE DICC APPROVED 02/2015 DATE LAST REVIEWED 11/4/13 DISCIPLINE COURSE TITLE COURSE INFORMATION FORM Health Information Management Healthcare Reimbursement Methodologies

More information

Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols

Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols 200 Old Country Road, Suite 470 Mineola, NY 11501 Phone: 516-294-4118 Fax: 516-294-9268 www.businessdynamicslimited.com

More information

Elements for Successful Immunization Billing Practice

Elements for Successful Immunization Billing Practice Elements for Successful Immunization Billing Practice at New York State s Local Health Departments June 2012 New York State Department of Health Bureau of Immunization and Office of Public Health Practice

More information

REIMBURSEMENT POLICY CMS-1500 Physical Medicine & Rehabilitation: Multiple Therapy Procedure Reduction Policy 2/13/2013

REIMBURSEMENT POLICY CMS-1500 Physical Medicine & Rehabilitation: Multiple Therapy Procedure Reduction Policy 2/13/2013 Policy Number REIMBURSEMENT POLICY CMS-1500 Physical Medicine & Rehabilitation: Multiple Therapy Procedure Reduction Policy 2013R0121C Annual Approval Date 2/13/2013 Approved By National Reimbursement

More information

Appendix A WORK PROCESS SCHEDULE HIM (HEALTH INFORMATION MANAGEMENT) HOSPITAL CODER O*NET-SOC CODE: 29-2071.00 RAPIDS CODE: TBD

Appendix A WORK PROCESS SCHEDULE HIM (HEALTH INFORMATION MANAGEMENT) HOSPITAL CODER O*NET-SOC CODE: 29-2071.00 RAPIDS CODE: TBD Appendix A WORK PROCESS SCHEDULE HIM (HEALTH INFORMATION MANAGEMENT) HOSPITAL CODER O*NET-SOC CODE: 29-2071.00 RAPIDS CODE: TBD This schedule is attached to and a part of these Standards for the above

More information

A medical coding specialist is a member of the medical records billing department who aids in insurance reimbursement.

A medical coding specialist is a member of the medical records billing department who aids in insurance reimbursement. A medical coding specialist is a member of the medical records billing department who aids in insurance reimbursement. Specifically, a medical coder interprets medical provider and procedure notes in order

More information

NC WORKERS COMPENSATION: BASIC INFORMATION FOR MEDICAL PROVIDERS

NC WORKERS COMPENSATION: BASIC INFORMATION FOR MEDICAL PROVIDERS NC WORKERS COMPENSATION: BASIC INFORMATION FOR MEDICAL PROVIDERS CURRENT AS OF APRIL 1, 2010 I. INFORMATION SOURCES Where is information available for medical providers treating patients with injuries/conditions

More information

EASTERN ARIZONA COLLEGE Professional Practice in Coding and Billing

EASTERN ARIZONA COLLEGE Professional Practice in Coding and Billing EASTERN ARIZONA COLLEGE Professional Practice in Coding and Billing Course Design 2014-2015 Course Information Division Allied Health Course Number HCE 216 Title Professional Practice in Coding and Billing

More information

INTERMEDIATE ADMINISTRATIVE SIMPLIFICATION CENTERS FOR MEDICARE & MEDICAID SERVICES. Online Guide to: ADMINISTRATIVE SIMPLIFICATION

INTERMEDIATE ADMINISTRATIVE SIMPLIFICATION CENTERS FOR MEDICARE & MEDICAID SERVICES. Online Guide to: ADMINISTRATIVE SIMPLIFICATION 02 INTERMEDIATE¬Ľ Online Guide to: CENTERS FOR MEDICARE & MEDICAID SERVICES Last Updated: February 2014 TABLE OF CONTENTS INTRODUCTION: ABOUT THIS GUIDE... i About Administrative Simplification... 2 Why

More information

4 NCAC 10F.0101 is proposed for amendment as follows: SUBCHAPTER 10F REVISED WORKERS COMPENSATION MEDICAL FEE SCHEDULE ELECTRONIC BILLING RULES

4 NCAC 10F.0101 is proposed for amendment as follows: SUBCHAPTER 10F REVISED WORKERS COMPENSATION MEDICAL FEE SCHEDULE ELECTRONIC BILLING RULES 1 1 1 1 1 1 NCAC F.01 is proposed for amendment as follows: SUBCHAPTER F REVISED WORKERS COMPENSATION MEDICAL FEE SCHEDULE ELECTRONIC BILLING RULES SECTION.00 RULES ADMINISTRATION NCAC F.01 ELECTRONIC

More information

AETNA MEDICARE OPEN SM PLAN PROVIDER TERMS AND CONDITIONS OF PAYMENT

AETNA MEDICARE OPEN SM PLAN PROVIDER TERMS AND CONDITIONS OF PAYMENT AETNA MEDICARE OPEN SM PLAN PROVIDER TERMS AND CONDITIONS OF PAYMENT Table of Contents 1. Introduction 2. When a provider is deemed to accept Aetna Medicare Open Plan s terms and conditions 3. Provider

More information

Billing and Claim Billing and Claim Submission Boot Camp Submission Boot Camp Beverly Remm Beverly Remm

Billing and Claim Billing and Claim Submission Boot Camp Submission Boot Camp Beverly Remm Beverly Remm Billing and Claim Submission Boot Camp Presented by: Beverly Remm Orion Healthcare Technology Billing and Claim Submission Boot Camp Presented by: Beverly Remm Orion Healthcare Technology The presentation

More information

The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle.

The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle. The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle. This Revenue Cycle Overview training will establish a

More information

SAFEGUARD YOUR REVENUE IN AN ERA OF CHANGE

SAFEGUARD YOUR REVENUE IN AN ERA OF CHANGE SAFEGUARD YOUR IN AN ERA OF CHANGE Regulatory, economic and technological changes have made running a hospital, urgent care center, or medical practice increasingly difficult today. The complexity of revenue

More information

New York University School of Medicine Faculty Group Practice Billing and Collection Policies

New York University School of Medicine Faculty Group Practice Billing and Collection Policies New York University School of Medicine Faculty Group Practice Billing and Collection Policies General Policy Statement New York University School of Medicine Faculty Group Practice (NYUSM- FGP) oversees

More information

SETTING YOUR ORGANIZATION UP FOR SUCCESS: UNDERSTANDING THE COMPLEXITIES OF THE REVENUE CYCLE

SETTING YOUR ORGANIZATION UP FOR SUCCESS: UNDERSTANDING THE COMPLEXITIES OF THE REVENUE CYCLE SETTING YOUR ORGANIZATION UP FOR SUCCESS: UNDERSTANDING THE COMPLEXITIES OF THE REVENUE CYCLE Kentucky Primary Care Association, 2016 Fall Conference Thursday, November 10, 2016 9:00am 10:15am The following

More information

ActivHealthCare EDI User Guide

ActivHealthCare EDI User Guide ActivHealthCare EDI User Guide Table of Contents Page Enrollment 2 Preparing Your Management Software 3 Claims Submission for AHC Network Affiliates 4 Online Entry Tool 7 Claims Follow-Up 8 Frequently

More information

Frequently Asked Questions about ICD-10

Frequently Asked Questions about ICD-10 Frequently Asked Questions about -10 Q: What is the current status of -10? A: The U.S. Department of Health and Human Services (HHS) has issued its final rule that the -9-CM code sets be replaced with

More information

Real-time Pre and Post Claim Edits: Improve Reimbursement, Compliance and Safety

Real-time Pre and Post Claim Edits: Improve Reimbursement, Compliance and Safety Real-time Pre and Post Claim Edits: Improve Reimbursement, Compliance and Safety An ESI Healthcare Business Solutions White Paper by Thomas Renshaw R.Ph. Introduction Outpatient pharmacies submitting claims

More information

REIMBURSEMENT CODING SERIES

REIMBURSEMENT CODING SERIES REIMBURSEMENT CODING SERIES Occ. Work Prob. Effective Last Code No. Class Title Area Area Period Date Action 4839 Reimbursement Coder 02 445 6 mo. 00/00/00 Rev. 4840 Reimbursement Coding Specialist 02

More information

Four rights can t be wrong: why now is the right time to implement an EHR

Four rights can t be wrong: why now is the right time to implement an EHR White Paper Four rights can t be wrong: why now is the right time to implement an EHR OptumInsight www.optum.com Page 1 White Paper EHRs and small to mid-size physician practices: Finding the right fit

More information

Insurance Terms 101. Patient Access Specialists I

Insurance Terms 101. Patient Access Specialists I Access Management Insurance Terms 101 University of Mississippi Medical Center Patient Access Specialists I As a Patient Access Specialist Your job is to collect ACCURATE patient information during registration.

More information

Financial Disclosure. Teri Thurston does not have any relevant financial relationships with any commercial interests

Financial Disclosure. Teri Thurston does not have any relevant financial relationships with any commercial interests Financial Disclosure Teri Thurston does not have any relevant financial relationships with any commercial interests Transitioning to ICD-10 Planning the Journey for Implementation 2 Brief History of ICD-10

More information

Revenue Cycle Objectives Challenges Management Goals and Expected Benefits Sample Metrics Opportunities Summary Solution Steps

Revenue Cycle Objectives Challenges Management Goals and Expected Benefits Sample Metrics Opportunities Summary Solution Steps Common Findings Revealed: Revenue Cycle Review John Bartell, RN, BSN, Partner Tina Nazier, MBA, Director Wipfli LLP Topics for Discussion Revenue Cycle Objectives Challenges Management Goals and Expected

More information

Revenue Cycle Management

Revenue Cycle Management Revenue Cycle Management 2007 Edition Copyright 2007 Revenue Integrity Specialist Team University of Arkansas for Medical Sciences All rights reserved INTRODUCTION Welcome! The program is facilitated by

More information

Administration 1. Charity Care Policy. March 2014

Administration 1. Charity Care Policy. March 2014 Administration 1 Charity Care Policy Chapter: Administration Release Date: March 2014 POLICY It is the policy of InterMedical Hospital of SC, Inc. (the "IMH") to provide care to all patients regardless

More information

ICD-10 Frequently Asked Questions For Providers

ICD-10 Frequently Asked Questions For Providers ICD-10 Frequently Asked Questions For Providers ICD-10 Basics ICD-10 Coding and Claims ICD-10 s ICD-10 Testing ICD-10 Resources ICD-10 Basics What is ICD-10? International Classification of Diseases, 10th

More information

SUPPORT PATH PROGRAM INTAKE FORM PHONE: 1-855-769-7284 FAX: 1-855-298-8700

SUPPORT PATH PROGRAM INTAKE FORM PHONE: 1-855-769-7284 FAX: 1-855-298-8700 SUPPORT PATH PROGRAM INTAKE FORM PHONE: 1-855-769-7284 FAX: 1-855-298-8700 1 REQUESTED SERVICE(S) (REQUIRED) CHECK ALL BOXES THAT APPLY Benefits Investigation Prior Authorization and Appeals Support Patient

More information

What Every Medical Practice Must Do to Optimize Workflow and Maximize Revenue While Decreasing Costs

What Every Medical Practice Must Do to Optimize Workflow and Maximize Revenue While Decreasing Costs What Every Medical Practice Must Do to Optimize Workflow and Maximize Revenue While Decreasing Costs Don t just trust that your staff is maximizing time and revenue. It is up to you to monitor, analyze

More information

Reimbursement Policy General Coding Section Policy Number: RP - General Coding - 014 Observation Care Services Effective Date: June 1, 2015

Reimbursement Policy General Coding Section Policy Number: RP - General Coding - 014 Observation Care Services Effective Date: June 1, 2015 Status Active Reimbursement Policy Section: General Coding Section Policy Number: RP - General Coding - 014 Observation Care Services Effective Date: June 1, 2015 Observation Care Services Description:

More information

Presentation title here

Presentation title here Presentation Provider toolbox title here Sylvia Strickland, MBA, Provider Reimbursement Presentation title here Bridgette Ampey, CPC, Code Review Jorri Smith, Network Innovation & Education priorityhealth.com

More information

HIT 210. Basic CPT Procedural Coding. Syllabus

HIT 210. Basic CPT Procedural Coding. Syllabus HIT 210 Basic CPT Procedural Coding Syllabus Instructor Jeanie Heck, BBA, CCS, CPC, FCS, PCS Email address Use Course Email (Internal Moodle email) Course Introduction This is a beginning level course

More information

Psychotherapy Professional Services

Psychotherapy Professional Services Status Active Reimbursement Policy Section: Behavioral Health Section Policy Number: RP - Behavioral Health - 001 Psychotherapy Professional Services Effective Date: June 1, 2015 Psychotherapy Professional

More information